Average Medicaid Office Visit Payments
Typical Medicaid Office Visit reimbursement across 14,934 cities
Avg. Medicaid Paid
$51.55
Price Range
$0.00 – $907.39
Total Claims
1469.2M
Cities
14934
Typical Payment Range
Typical Medicaid Office Visit payments fall between $29.28 and $67.92 per claim (median: $46.55). The top 10% of payments exceed $95.29.
Based on per-provider averages across all Medicaid claims in this category.
About This Procedure
A standard doctor's office visit for evaluation and management of medical conditions. Includes new patient visits, follow-up visits, and consultations.
Why do these costs look low?
These figures represent Medicaid reimbursement rates — the amounts that state Medicaid programs actually paid providers. Medicaid typically reimburses significantly less than private insurance or out-of-pocket prices. If you have private insurance or are paying cash, expect higher costs. See the cost components below for per-code averages.
Costs by City
| City | Avg. Paid | Min / Max | Claims | Providers |
|---|---|---|---|---|
| Weiner, AR | $23.43 | $14.60 – $29.97 | 1,077 | 2 |
| Conosburg, PA | $70.27 | $70.27 – $70.27 | 1,078 | 1 |
| Lake Park, FL | $17.93 | $0.00 – $38.40 | 1,078 | 6 |
| Antioch, IL | $33.72 | $24.60 – $48.71 | 1,078 | 3 |
| Yautat, AK | $442.90 | $442.90 – $442.90 | 1,078 | 1 |
| Akron, NY | $40.99 | $40.69 – $41.66 | 1,078 | 2 |
| Upper Lake, CA | $17.85 | $17.85 – $17.85 | 1,083 | 1 |
| Moore Haven, FL | $40.36 | $20.85 – $48.81 | 1,085 | 3 |
| Canaan, NH | $28.17 | $15.22 – $40.21 | 1,085 | 5 |
| Hickory, MS | $55.01 | $52.99 – $55.09 | 1,085 | 2 |
| Fall Branch, TN | $49.41 | $49.41 – $49.41 | 1,087 | 1 |
| Rock Point, AZ | $31.14 | $29.81 – $76.60 | 1,087 | 2 |
| Ansted, WV | $19.26 | $0.14 – $46.47 | 1,088 | 2 |
| Stone Ridge, VA | $75.94 | $70.29 – $76.27 | 1,088 | 2 |
| Arcadia, IN | $26.35 | $26.35 – $26.35 | 1,089 | 1 |
| Belle Harbor, NY | $92.55 | $61.31 – $102.44 | 1,090 | 2 |
| Sainte Genevieve, MO | $85.61 | $31.19 – $92.67 | 1,091 | 3 |
| Perkinsville, VT | $83.55 | $83.55 – $83.55 | 1,091 | 1 |
| Hartington, NE | $79.65 | $36.35 – $88.51 | 1,091 | 3 |
| Camargo, IL | $51.52 | $49.60 – $52.56 | 1,092 | 2 |
| Langley, KY | $27.99 | $27.99 – $27.99 | 1,092 | 1 |
| Huffman, TX | $82.03 | $21.51 – $141.43 | 1,092 | 3 |
| Boyd, TX | $43.79 | $38.72 – $45.38 | 1,092 | 2 |
| Cross River, NY | $66.50 | $66.50 – $66.50 | 1,093 | 1 |
| Riggins, ID | $0.44 | $0.00 – $5.27 | 1,094 | 2 |
| Clark, SD | $52.30 | $52.30 – $52.30 | 1,096 | 1 |
| Ausitn, TX | $90.62 | $90.62 – $90.62 | 1,097 | 1 |
| South Russell, OH | $28.74 | $26.02 – $41.18 | 1,099 | 3 |
| Gonzalez, CA | $26.08 | $26.08 – $26.08 | 1,099 | 1 |
| Armour, SD | $67.32 | $67.32 – $67.32 | 1,100 | 1 |
| Spring Mills, PA | $46.63 | $27.85 – $52.19 | 1,100 | 4 |
| Stewart, OH | $19.27 | $0.00 – $21.07 | 1,100 | 2 |
| T Or C, NM | $113.00 | $101.23 – $231.56 | 1,100 | 3 |
| Holts Summit, MO | $58.36 | $55.67 – $102.50 | 1,102 | 3 |
| Eastport, NY | $101.11 | $101.11 – $101.11 | 1,103 | 1 |
| Rio Piedrad, PR | $0.00 | $0.00 – $0.00 | 1,105 | 1 |
| Marlboro Township, NJ | $68.67 | $68.67 – $68.67 | 1,106 | 1 |
| Dearborn Hts, MI | $59.60 | $59.60 – $59.60 | 1,108 | 1 |
| Intervale, NH | $23.57 | $23.57 – $23.57 | 1,109 | 1 |
| Swannanoa, NC | $109.41 | $69.36 – $110.03 | 1,110 | 2 |
| Little Canada, MN | $69.96 | $69.44 – $79.66 | 1,110 | 2 |
| Belleville, WI | $19.49 | $14.59 – $36.54 | 1,110 | 10 |
| Gerogetown, OH | $61.51 | $61.51 – $61.51 | 1,110 | 1 |
| Boring, MD | $107.49 | $107.49 – $107.49 | 1,111 | 1 |
| Pittsburgh, KS | $20.54 | $20.54 – $20.54 | 1,112 | 1 |
| Cedar Grove, WI | $29.39 | $27.41 – $30.13 | 1,112 | 2 |
| Apache, OK | $58.99 | $58.99 – $58.99 | 1,112 | 1 |
| Counselor, NM | $141.21 | $141.21 – $141.21 | 1,115 | 1 |
| Nakina, NC | $7.77 | $7.77 – $7.77 | 1,116 | 1 |
| Pentwater, MI | $5.71 | $5.71 – $5.71 | 1,116 | 1 |
Cost Components
National averages for each billing code in this procedure category. Sorted by claim volume.
| Code | Description | Avg. Paid | Claims | Providers |
|---|---|---|---|---|
| 99213 | Office visit established mod | $43.18 | 764,306,590 | 487,602 |
| 99214 | Office visit established mod-hi | $59.53 | 502,480,931 | 466,856 |
| 99212 | Office visit established low | $41.69 | 92,299,154 | 127,462 |
| 99203 | Office visit new moderate | $67.55 | 47,756,882 | 127,334 |
| 99211 | Office visit established minor | $39.24 | 44,127,221 | 47,748 |
| 99204 | Office visit new moderate-high | $92.03 | 32,379,031 | 111,937 |
| 99215 | Office visit established high | $93.58 | 29,619,773 | 74,725 |
| 99202 | Office visit new low | $58.57 | 9,372,712 | 35,486 |
| 99205 | Office visit new high | $136.10 | 3,665,382 | 19,737 |
| 99244 | Office consultation mod-high | $118.25 | 3,405,681 | 11,884 |
| 99243 | Office consultation moderate | $78.55 | 2,585,480 | 8,432 |
| 99245 | Office consultation high | $132.29 | 645,300 | 3,046 |
| 99242 | Office consultation low | $58.27 | 483,445 | 1,980 |
| 99241 | Office consultation brief | $66.15 | 295,664 | 712 |
These averages group common billing codes used when providers bill Medicaid for this procedure. Individual costs will vary.